CMS Gives Conditional Approval to Plan to Spend $350M in Federal Match to Improve Medicaid Home and

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The Centers for Medicare and Medicaid Services (CMS) on Sept. 3 gave conditional approval of the Wisconsin Department of Health Services (DHS) plan to spend a federal funding boost of more than $350 million to improve and enhance Wisconsin’s home and community-based services (HCBS) under Medicaid, Curtis Cunningham, DHS Assistant Administrator, Benefits & Service Delivery, said at Tuesday's LTC Advisory Council meeting.

DHS estimates the state will receive $353.2 million from the 10% bump in federal matching funds under the American Rescue Plan Act (ARPA).

Key components of Wisconsin's plan include increasing rates for home and community-based services and expanding the professional advancement opportunities for the workers who provide these services.

The proposal was discussed at Tuesday's Wisconsin Long-Term Care Advisory Council meeting. The six key components of the spending plan, which was developed with input from stakeholders earlier this year, include:

Medicaid HCBS Workforce, Provider Capacity, and Fiscal Stability 

  • Increase rates for all HCBS services by 5% in CY22.
  • Contract with an actuarial firm to develop a rate schedule for Medicaid long-term care providers along with subsequent one-time funding over the two-year period of FY23 and FY24 that would allow DHS to smooth the implementation of the new provider rate schedule. 
  • Fund initial implementation of a direct care service career ladder rate structure, in the form of tiered payment rates for personal care and supportive home care workers. DHS proposes to develop professional career ladders for personal care workers and supportive home care workers. 

Promoting Quality and Innovation Resources 

Wisconsin proposes to implement statewide training modules and offer grant funding opportunities for providers to invest in workforce training, including development and implement specialized direct care worker and manager training programs. Focus areas for training programs developed under this initiative include: 

  • Best Practices in Direct Care 
  • Supportive Home Care Skills 
  • Personal Care 1 and Personal Care 2 
  • Direct Support Professional Manager 
  • Equity and Diversity for Direct Care Workers 
  • Equity and Diversity for Managers 
  • Case Management, Assessment, and Person-Centered Planning 
  • Training for Supported Employment Providers 
  • Direct Care Skills for Special Populations (Some focus areas include: Dementia, Autism Spectrum Disorder, Individuals with Complex Behaviors) 
  • Housing Resources 
  • Crisis Prevention and De-escalation 
  • Volunteer management systems and supports 

Tribal Long-Term Care Systems 

Wisconsin proposes to work in partnership with Wisconsin tribes to further develop tribal long-term care systems that address their unique cultural and policy needs of these nations. Wisconsin is in the process of surveying all 11 federally-recognized tribes to determine their needs and wants as it relates to the provision of long-term care services to tribal members. Additionally, Wisconsin proposes to increase the funding for tribal Aging and Disability Resource Services to an amount that is commensurate with the necessary knowledge and experience to do this work effectively. 

Independent Living and Family/Informal Caregiver Resources 

This item has been characterized as a "Family Care diversion" initiative. Wisconsin proposes to pilot a two-year independent living and caregiver support program offering capped annual reimbursement for intermittent and one-time services and supports for qualifying individuals and informal caregivers. As part of this pilot, DHS proposes to contract for the development of an individual and a caregiver needs assessment, to gain a better understanding of the needs of the pre-Medicaid population and those who provide care for them in the community. In addition, DHS is proposing to contract for pilot program evaluation study to help inform the state’s development of future interventions, based on evidence demonstrating best practices for achieving longer-term independence and continuing engagement of informal caregiving resources. 

Access to HCBS Information and Services 

DHS proposes to modernize the Aging and Disability Resource Centers (ADRC) service delivery model, including development of a virtual access portal for Medicaid long-term care members to manage certain routine aspects of their program benefits, which would allow ADRCs to advance other goals identified for implementation. Wisconsin will also consider investing in implementation of a statewide outreach campaign to increase visibility of ADRC resources. 

Assisted Living Information, Analysis and Quality Oversight 

DHS proposes to pilot an assisted living information reporting tool, to collect information about facilities and their residents, which can be used to inform facility certification e-renewals and assess the capacity of these facilities to serve Wisconsinites in the future. Additionally, Wisconsin requests using the funds for the development of a member assessment that could be used to better understand the acuity and needs of individuals in the HCBS system, both in assisted living and in the community. DHS also proposes to explore ways to improve quality oversight for 1-2 bed adult family homes in Wisconsin.

Wisconsin submitted the plan to CMS in July. With conditional approval received, DHS now plans to ramp up implementation of the numerous items in the plan, Curtis Cunningham, DHS Assistant Administrator, Benefits & Service Delivery, said at Tuesday's LTC Advisory Council meeting. Cunningham said DHS staff are busy trying to map out all of these projects, get project management support and developing teams to implement the proposals.

The 5% rate increase to HCBS providers will happen in January 2022, he said. Other parts of the plan will take more time to implement, such as the rate schedule and career ladder proposals.

The plan is subject to being amended, Cunningham also noted.

"We're at the start of a long process to do a lot of good work," he said.

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